TY - JOUR
T1 - Perceptions of Facilitators and Barriers to Measuring and Improving Quality in Palliative Care Programs
AU - Kuchinad, Kamini
AU - Sharma, Ritu
AU - Isenberg, Sarina R.
AU - Hamayel, Nebras Abu Al
AU - Weaver, Sallie J.
AU - Zhu, Junya
AU - Hannum, Susan M.
AU - Kamal, Arif H.
AU - Walling, Anne M.
AU - Lorenz, Karl A.
AU - Ailon, Jonathan
AU - Dy, Sydney M.
N1 - Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R21CA197362. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Walling was supported by the Cambia Health Foundation Sojourns Scholar Leadership Award. Dr Isenberg’s work was supported in part by the Canadian Institutes of Health Research #146181.
Funding Information:
The authors would like to acknowledge the Department of Supportive Care Medicine, Moffitt Cancer Center. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R21CA197362. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Walling was supported by the Cambia Health Foundation Sojourns Scholar Leadership Award. Dr Isenberg?s work was supported in part by the Canadian Institutes of Health Research #146181.
Publisher Copyright:
© The Author(s) 2020.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Objective: To examine perceptions of facilitators and barriers to quality measurement and improvement in palliative care programs and differences by professional and leadership roles. Methods: We surveyed team members in diverse US and Canadian palliative care programs using a validated survey addressing teamwork and communication and constructs for educational support and training, leadership, infrastructure, and prioritization for quality measurement and improvement. We defined key facilitators as constructs rated ≥4 (agree) and key barriers as those ≤3 (disagree) on 1 to 5 scales. We conducted multivariable linear regressions for associations between key facilitators and barriers and (1) professional and (2) leadership roles, controlling for key program and respondent factors and clustering by program. Results: We surveyed 103 respondents in 11 programs; 45.6% were physicians and 50% had leadership roles. Key facilitators across sites included teamwork, communication, the implementation climate (or environment), and program focus on quality improvement. Key barriers included educational support and incentives, particularly for quality measurement, and quality improvement infrastructure such as strategies, systems, and skilled staff. In multivariable analyses, perceptions did not differ by leadership role, but physicians and nurse practitioners/nurses/physician assistants rated most constructs statistically significantly more negatively than other team members, especially for quality improvement (6 of the 7 key constructs). Conclusions: Although participants rated quality improvement focus and environment highly, key barriers included lack of infrastructure, especially for quality measurement. Building on these facilitators and measuring and addressing these barriers might help programs enhance palliative care quality initiatives’ acceptability, particularly for physicians and nurses.
AB - Objective: To examine perceptions of facilitators and barriers to quality measurement and improvement in palliative care programs and differences by professional and leadership roles. Methods: We surveyed team members in diverse US and Canadian palliative care programs using a validated survey addressing teamwork and communication and constructs for educational support and training, leadership, infrastructure, and prioritization for quality measurement and improvement. We defined key facilitators as constructs rated ≥4 (agree) and key barriers as those ≤3 (disagree) on 1 to 5 scales. We conducted multivariable linear regressions for associations between key facilitators and barriers and (1) professional and (2) leadership roles, controlling for key program and respondent factors and clustering by program. Results: We surveyed 103 respondents in 11 programs; 45.6% were physicians and 50% had leadership roles. Key facilitators across sites included teamwork, communication, the implementation climate (or environment), and program focus on quality improvement. Key barriers included educational support and incentives, particularly for quality measurement, and quality improvement infrastructure such as strategies, systems, and skilled staff. In multivariable analyses, perceptions did not differ by leadership role, but physicians and nurse practitioners/nurses/physician assistants rated most constructs statistically significantly more negatively than other team members, especially for quality improvement (6 of the 7 key constructs). Conclusions: Although participants rated quality improvement focus and environment highly, key barriers included lack of infrastructure, especially for quality measurement. Building on these facilitators and measuring and addressing these barriers might help programs enhance palliative care quality initiatives’ acceptability, particularly for physicians and nurses.
KW - palliative care
KW - quality
KW - quality improvement
KW - quality measurement
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U2 - 10.1177/1049909120916702
DO - 10.1177/1049909120916702
M3 - Article
C2 - 32336104
AN - SCOPUS:85086032677
SN - 1049-9091
VL - 37
SP - 1022
EP - 1028
JO - American Journal of Hospice and Palliative Medicine
JF - American Journal of Hospice and Palliative Medicine
IS - 12
ER -